脑脊液置换联合蛋白A免疫吸附治疗自身免疫性脑炎两例  

Autoimmune encephalitis treated by CSF replacement combined with protein A immunoadsorption:a report of two cases

作　　者：邱家琦 王翼洁 刘佳[1] 徐晓峰[1] 江滢[1] 彭福华[1] Qiu Jiaqi;Wang Yijie;Liu Jia;Xu Xiaofeng;Jiang Ying;Peng Fuhua(Department of Neurology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院神经内科,广州510630 [2]南方医科大学第五附属医院神经内科,广州510900

出　　处：《新医学》2020年第4期321-324,共4页Journal of New Medicine

摘　　要：自身免疫性脑炎(AE)是指自身免疫反应引起的中枢神经系统炎性疾病.快速清除自身抗体是AE的主要治疗方法之一.该文报道了2例接受脑脊液置换联合蛋白A免疫吸附治疗的AE患者,并结合文献总结免疫吸附治疗的特点和优势.2例AE患者经脑脊液置换联合蛋白A免疫吸附治疗后精神状态均好转;Ig较治疗前明显下降,其中以IgG下降明显;同时脑脊液细胞数减少,总蛋白减少,血清及脑脊液抗体滴度较前明显下降,症状明显好转出院.脑脊液置换主要降低脑脊液抗体滴度,而免疫吸附治疗主要清除血浆中抗体,由该2例疗效可推测脑脊液置换联合免疫吸附治疗AE可以明显改善患者的临床症状.Autoimmune encephalitis(AE)refers to an inflammatory disease of the central nervous system caused by autoimmune reaction.Rapid eradication of autoantibodies is one of the main therapeutic methods for AE.In this article,two AE patients treated with cerebrospinal fluid(CSF)replacement combined with protein A immunoadsorption were reported.Literature review was performed to summarize the characteristics and advantages of immunoadsoprtion therapy.After the combined treatment of CSF replacement and protein A immunoadsorption,the mental state of two patients was improved and the immunoglobulin level was significantly decreased,especially the IgG level.In addition,the number of CSF cells was decreased,the total protein level was reduced,the antibody titers of serum and CSF were considerably declined and relevant symptoms were significantly mitigated.Both two patients were discharged.CSF replacement mainly lowered the antibody titer of CSF,whereas immunoadsorption therapy primarily eliminated the antibody in the plasma.Therefore,we hypothesize that CSF replacement combined with immunoadsorption can significantly alleviate the clinical symptoms of AE patients.

关 键 词：自身免疫性脑炎 脑脊液置换 免疫吸附治疗 葡萄球菌蛋白A 

分 类 号：R742.9[医药卫生—神经病学与精神病学]